EMAS Position Statements and Clincial Guides
Management of urinary incontinence in postmenopausal women: An EMAS clinical guideUrinary incontinence (UI) is defined as a “complaint of involuntary loss of urine” . The prevalence of the condition increases with age, and it is reported to affect 58%–84% of elderly women . The reported prevalence of UI varies widely because of the different definitions and assessment tools for diagnosis employed . The general prevalence is reported to be between 38 % and 55 % in women over 60 years . Despite this high prevalence, UI remains underdiagnosed and undertreated. Up to half of women may not report incontinence to their healthcare provider and this may be due to embarrassment or to the belief that UI is a normal part of aging.
European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosisWorldwide, it is estimated about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018 the predicted annual totals were cervix uteri 569,847, corpus uteri 382,069, ovary 295,414, vulva 44,235 and vagina 17,600 .
EMAS position statement: Predictors of premature and early natural menopauseTiming of menopause is an indicator of ovarian function and has important health implications. Natural menopause is commonly defined as the time when a woman has experienced 12 consecutive months of amenorrhoea without obvious cause , such as removal of both ovaries (bilateral oophorectomy), chemotherapy or radiotherapy for cancer. The International collaboration on the Life course Approach to reproductive health and Chronic disease Events (InterLACE)  recently reported that the average age at natural menopause across 21 studies from 10 countries ranged from 47 to 53 years, varying across ethnic groups from 48 years for women of South Asian background to 50 years for Caucasian women living in Australia and Europe, and 52 years for Japanese women .
Menopause and diabetes: EMAS clinical guideDiabetes mellitus (DM) is a public health problem, especially in developed countries. It affects about 9.1% of the adult population in Europe and 13.3% in the United States of America . The greater prevalence of DM in developed countries is broadly associated with ageing of the population . Between 2015 and 2030, the world population aged over 60 years is projected to increase by 56%, from 901 million to 1.4 billion; by 2050 it is expected to reach nearly 2.1 billion . These data suggest that the number of postmenopausal women with DM will grow substantially.
Current management of pelvic organ prolapse in aging women: EMAS clinical guidePelvic floor disorders include pelvic organ prolapse (POP), urinary incontinence (UI), fecal incontinence, pelvic pain and sexual dysfunction.
Calcium in the prevention of postmenopausal osteoporosis: EMAS clinical guideOsteoporosis is a chronic disease with a growing prevalence due to the increase in life expectancy . It is far more common in women than in men, and its prevalence increases markedly after the menopause. Approximately 30% of all postmenopausal women have osteoporosis in the United States and Europe, and at least 40% of these women will suffer one or more fragility fractures . As with other chronic diseases affecting modern societies, such as cardiovascular disease and cancer, risk reduction is a preferred strategy.
Drug holidays from bisphosphonates and denosumab in postmenopausal osteoporosis: EMAS position statementBisphosphonates are structural analogues of inorganic pyrophosphate, where the oxygen atom has been substituted by a carbon atom. Differences in the R2 side-chain bound to the carbon atom and the nitrogen group determine their variations in duration of action, bone affinity and anti-fracture efficacy [1,2]. Bisphosphonates inhibit enzymes involved in osteoclastic activity, and thus suppress bone resorption [1,2]. The main bisphosphonates are alendronate, risedronate, ibandronate and zoledronic acid, which constitute the first-line therapeutic agents in both postmenopausal and male osteoporosis, as they have well-documented anti-fracture efficacy [1,2].
Interventions to reduce the risk of ovarian and fallopian tube cancer: A European Menopause and Andropause Society Position StatementApproximately 1.3% of women will be diagnosed with ovarian cancer at some point during their life. Mortality is high, with a 5-year survival rate ranging from 36% to 46%, although there has been a net survival improvement during the last decades, especially among young and mid-aged women [1,2].
Osteoporosis management in patients with breast cancer: EMAS position statementBreast cancer remains the most frequent cancer in women and its incidence is increasing. However, the mortality rate has stabilized due to the progress made in the treatment of breast cancer over the last decade. In premenopausal women with hormone receptor-positive breast cancer, the goal of adjuvant treatment is to inhibit the impact of estrogen on the breast, either by blocking the estrogen receptors (with the use of tamoxifen) or by suppressing ovarian function (through surgical oophorectomy or treatment with luteinizing hormone-releasing hormone (LHRH) agonist).
A model of care for healthy menopause and ageing: EMAS position statementThe menopause can now be considered to be a mid-life event as the lifespan of women continues to increase in developed countries . By the year 2025, the number of postmenopausal women is expected to rise to 1.1 billion worldwide. Although not all women will experience short- or long-term problems of menopause, the high prevalence of hot flushes [2,3] and vaginal atrophy [2,4], which can last for many years, as well as osteoporosis (1 in 3 women are at risk of an osteoporotic fracture) , makes caring for ageing women a key issue for health professionals.
Maintaining postreproductive health: A care pathway from the European Menopause and Andropause Society (EMAS)This position statement from the European Menopause and Andropause Society (EMAS) provides a care pathway for the maintenance of women’s health during and after the menopause. It is designed for use by all those involved in women’s health. It covers assessment, screening for diseases in later life, treatment and follow-up. Strategies need to be optimised to maintain postreproductive health, in part because of increased longevity. They encompass optimising diet and lifestyle, menopausal hormone therapy and non-estrogen-based treatment options for climacteric symptoms and skeletal conservation, personalised to individual needs.
EMAS recommendations for conditions in the workplace for menopausal womenOccupational health issues for older workers in general, and older women workers in particular, have often been ignored. Women form a large part of many workforces throughout Europe. The number of persons in employment in EU Member States rose between 2013 and 2014 by around 2.3 million, to 217.8 million in 2014 . The employment rate for men was just over 70%, and for women, nearly 60%. A longer-term comparison shows that while the employment rate for men in 2014 was below its corresponding level ten years earlier, there was a marked increase in the proportion of women in employment.
EMAS position statement: Non-hormonal management of menopausal vasomotor symptomsTo review non-hormonal therapy options for menopausal vasomotor symptoms. The current EMAS position paper aims to provide to provide guidance for managing peri- and postmenopausal women who cannot or do not wish to take menopausal hormone therapy (MHT).
EMAS position statement: The ten point guide to the integral management of menopausal healthWith increased longevity and more women becoming centenarians, management of the menopause and postreproductive health is of growing importance as it has the potential to help promote health over several decades. Women have individual needs and the approach needs to be personalised. The position statement provides a short integral guide for all those involved in menopausal health. It covers diagnosis, screening for diseases in later life, treatment and follow-up.
EMAS position statement: Individualized breast cancer screening versus population-based mammography screening programmesBreast cancer originates from the malignant transformation of epithelial cells within the ducts and lobules of the breast. A malignant cell is the result of the accumulation of consecutive mutations. Up or down regulation of different mutated genes will ultimately result in the heterogeneity of breast cancers . Some tumors will remain in situ and will never threaten the health of women. Other tumors will become invasive and ultimately metastasize and hence be fatal when not treated. The doubling time of tumor cells is estimated between 150 and 200 days .
EMAS position statement: Management of uterine fibroidsUterine fibroids (also termed leiomyomas or myomas) are the most common tumors of the female reproductive tract.
EMAS position statement: The management of postmenopausal women with vertebral osteoporotic fractureOsteoporotic vertebral fractures are associated with significant morbidity, excess mortality as well as health and social service expenditure. Additionally, women with a prevalent osteoporotic vertebral fracture have a high risk of experiencing a further one within one year. It is therefore important for the physician to use a diagnostic and therapeutic algorithm for early detection and effective treatment of vertebral fractures.
EMAS position statement: Menopause for medical studentsDiscussions with patients about the menopause are becoming more complex because of women's increasing longevity, the wide range of therapeutic options, the controversies regarding menopausal hormone therapy (MHT) and the increasing use of alternative and complementary therapies. The aim of this document is to provide guidance in bullet-point style on the essential issues that medical students need to know about the stages of reproductive aging, menopause terminology, menopause and postmenopausal health .
EMAS position statement: Fertility preservationThe increasing incidence of malignant diseases that often require gonadotoxic treatment and the tendency to become a parent later in life result in an increased need for fertility preservation.
EMAS position statement: Late parenthoodDuring the last decades, couples in Europe have been delaying parenthood, mainly due to socio-demographic factors that include increased rates of university education and employment in women and poorer financial status.
EMAS clinical guide: Assessment of the endometrium in peri and postmenopausal womenInvasive as well as non-invasive methods are available for assessment of the endometrium.
EMAS clinical guide: Vulvar lichen sclerosus in peri and postmenopausal womenVulvar lichen sclerosus (LS) is a chronic inflammatory disease which affects genital labial, perineal and perianal areas, producing significant discomfort and psychological distress. However there may be diagnostic delay because of late presentation and lack of recognition of symptoms.
EMAS position statement: Diet and health in midlife and beyondThere is increasing evidence that life-style factors, such as nutrition, physical activity, smoking and alcohol consumption have a profound modifying effect on the epidemiology of most major chronic conditions affecting midlife health.
EMAS clinical guide: Low-dose vaginal estrogens for postmenopausal vaginal atrophyVaginal atrophy is common in postmenopausal women. This clinical guide provides the evidence for the clinical use of vaginal estrogens for this condition focussing on publications since the 2006 Cochrane systematic review. Use after breast cancer, before assessment of cervical cytology and prolapse surgery is also discussed.